Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: a review of assessment modalities

Assessing the driving abilities of individuals with disabilities is often a very challenging task because each medical condition is accompanied by physical impairments and because relative individual functional performance may vary depending on personal characteristics.We identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving.An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases.This article compares the current assessments of driving performance for those with lower extremity impairments with the assessments used for able-bodied persons. Very few articles were found concerning “Lower Extremity Disabilities,” thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate persons with lower extremity impairment

Técnicas de avaliação proprioceptiva do ligamento cruzado anterior do joelho

Com o aumento do interesse por atividades esportivas, bem como a vulnerabilidade e complexidade anatômica do joelho justificam um aumento crescente do número de pacientes com lesões ligamentares, principalmente do ligamento cruzado anterior (LCA). Entretanto qual é a melhor forma de avaliar a propriocepção do joelho? Objetivo: Desta forma este estudo teve como objetivo identificar as técnicas de avaliação proprioceptivas do LCA do joelho, e se existe a melhor técnica. Métodos: Foi realizada uma revisão de literatura, tendo como critérios de inclusão os estudos publicados em revistas científicas indexadas, que se referiam a instrumentos de avaliação e/ ou mensuração da propriocepção do joelho. Discussão: De acordo com a literatura revisada, existem diferentes técnicas de avaliação da propriocepção do LCA, dentre elas: estudos morfológicos anatômicos; avaliação neurofisiológica; e avaliação clínica que é dividida em três subtipos: a) sentido da posição estática; b) cinestesia; e c) equilíbrio postural. Ainda que a propriocepção seja importante no resultado final de um tratamento que envolva uma lesão ligamentar, sua avaliação ainda é uma dificuldade. Conclusão: O método ideal deve ter alta sensibilidade e especificidade, além de boa reprodutibilidade e precisão. Porém não houve consenso na literatura referente à melhor técnica e os resultados são contraditórios, apesar da avaliação do equilíbrio ser uma técnica moderna e utilizada nos grandes centros de pesquisa, não é possível isolar o sistema proprioceptivo dos outros sistemas: visual e vestibular.The increasing interest in sports activities, combined with the knee’s anatomical vulnerability and complexity, justifies the increasing number of patients with ligament injuries, especially the anterior cruciate ligament (ACL). What then would be the best way to evaluate the knee proprioception? The objective of this study was to identify the techniques of proprioceptive evaluation of the anterior cruciate knee ligament (ACL), and to determine whether a better technique is available. The method was to review the literature, including only those studies published in indexed scientific journals that referred to evaluation tools and/or knee proprioception measurement. The discussion of the different methods of evaluating ACL proprioception, according to the literature, included: morphological anatomical studies; neurophysiologic evaluation, and clinical evaluation which was divided into three types: a) sense of static position; b) kinesthetic posture; and c) postural balance. Although proprioception is important to the final results of a treatment involving ligament injury, its evaluation is still a problem. The conclusion was that the ideal method should have high sensitivity and specificity, in addition to good reproducibility and accuracy. There is lack of consensus in literature regarding the best evaluation technique and the results are also contradictory, despite the balance evaluation being a modern technique used in major research centers, it was not possible to isolate the proprioceptive system from other systems: visual and vestibular

Assessment of muscular function in peripheral arterial obstructive disease with the use of isokinetic dynamometry

Individuals with peripheral arterial obstructive disease present functional deficits, mainly in the lower limbs, generating an impaired walking capacity. In order to assess this deficit and ambulatory follow-up, walking tests are routinely used. In elderly patients, who present associated multiple and limiting comorbidities, in addition to the symptoms of intermittent claudication, the evaluation by walking tests becomes difficult, mainly in cases of bilateral disease with different affection, where the more severely affected limb limits the evaluation of the less severely affected one. The muscular isokinetic assessment is an alternative method to individually evaluate the disease-generated deficits of the different muscular groupings in ischemic territories, thus overcoming the difficulties and deficits presented by patients at the walking tests.Indivíduos com doença arterial obstrutiva periférica apresentam perda funcional, principalmente em membros inferiores, gerando prejuízo da capacidade de caminhada. Os testes de caminhada são rotineiramente utilizados para avaliação e seguimento desses pacientes. Em pacientes idosos, com comorbidades e limitações associadas à claudicação intermitente, torna-se difícil a avaliação pela caminhada, principalmente nos casos de doença bilateral com acometimento desigual, onde o membro mais afetado limita a avaliação do menos afetado. A avaliação muscular isocinética é uma metodologia alternativa aos testes de caminhada para avaliar de forma individualizada as perdas funcionais geradas pela doença nos diferentes grupamentos musculares em territórios isquêmicos

Muscle strength and body composition in severe obesity

OBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity

PREDIÇÃO DE HABILIDADES COGNITIVAS POR MEIO DAS CAPACIDADES FÍSICAS DE ACORDO COM SEXO

Este estudo teve como objetivo analisar se as capacidades físicas e nível de escolaridade de idosos são capazes de predizer suas habilidades cognitivas, considerando ainda se há influência do sexo na execução de tarefas simultâneas. Para tanto, foram avaliados 100 idosos com 60 anos ou mais de idade, de ambos os sexos, a partir da utilização dos instrumentos Montreal Cognitive Assesment (MoCA), a fim de verificar comprometimentos cognitivos, mensuração da força de preensão palmar por meio da medida no dinamômetro Jamar®, e mensuração da mobilidade funcional pelo teste Timed Get Up and Go (TUG), com e sem tarefa cognitiva. Os resultados obtidos neste estudo demonstraram que a idade, o nível de escolaridade e as capacidades físicas, a especificar a força de preensão palmar e mobilidade funcional, são capazes de predizer o desempenho no teste cognitivo MoCA, além de que os valores preditores encontrados são diferentes conforme o sexo em idosos. Concluiu-se que há relações entre capacidades físicas e o desempenho cognitivo em idosos, sendo esta última variável influenciada pelo grau de escolaridade apresentada pelo indivíduo. Ainda, cita-se a importância de adotar dinâmicas intervencionistas eficazes e mais adaptadas conforme o sexo, a fim de proporcionar uma melhora cognitiva na população idosa

Response to fatigue observed through magnetic resonance imaging on the quadriceps muscle in postmenopausal women

OBJECTIVES: Menopause marks the end of women’s reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women. METHODS: This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises. RESULTS: The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (po0.05) in the T2 signal of the nuclear MRI in the quadriceps muscle after carrying out exercises using both thighs. In the intergroup comparison, no statistically significant difference was observed between the OG and CG, pre- (p=0.343) and postexercise (p=0.874). CONCLUSION: The acute muscular activation of the quadriceps evaluated by T2 mapping on nuclear MRI equipment is equal in women with and without OP in the postmenopausal phase. BMD did not interfere with muscle response to exercise when muscle fatigue was reached

Muscle Activation Differs between Three Different Knee Joint-Angle Positions during a Maximal Isometric Back Squat Exercise

The purpose of this study was to compare muscle activation of the lower limb muscles when performing a maximal isometric back squat exercise over three different positions. Fifteen young, healthy, resistance-trained men performed an isometric back squat at three knee joint angles (20°, 90°, and 140°) in a randomized, counterbalanced fashion. Surface electromyography was used to measure muscle activation of the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), semitendinosus (ST), and gluteus maximus (GM). In general, muscle activity was the highest at 90° for the three quadriceps muscles, yet differences in muscle activation between knee angles were muscle specific. Activity of the GM was significantly greater at 20° and 90° compared to 140°. The BF and ST displayed similar activation at all joint angles. In conclusion, knee position alters muscles activation of the quadriceps and gluteus maximus muscles. An isometric back squat at 90° generates the highest overall muscle activation, yet an isometric back squat at 140° generates the lowest overall muscle activation of the VL and GM only

Muscle strength and body composition in severe obesity

OBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity

PREDIÇÃO DE HABILIDADES COGNITIVAS POR MEIO DAS CAPACIDADES FÍSICAS DE ACORDO COM SEXO

Este estudo teve como objetivo analisar se as capacidades físicas e nível de escolaridade de idosos são capazes de predizer suas habilidades cognitivas, considerando ainda se há influência do sexo na execução de tarefas simultâneas. Para tanto, foram avaliados 100 idosos com 60 anos ou mais de idade, de ambos os sexos, a partir da utilização dos instrumentos Montreal Cognitive Assesment (MoCA), a fim de verificar comprometimentos cognitivos, mensuração da força de preensão palmar por meio da medida no dinamômetro Jamar®, e mensuração da mobilidade funcional pelo teste Timed Get Up and Go (TUG), com e sem tarefa cognitiva. Os resultados obtidos neste estudo demonstraram que a idade, o nível de escolaridade e as capacidades físicas, a especificar a força de preensão palmar e mobilidade funcional, são capazes de predizer o desempenho no teste cognitivo MoCA, além de que os valores preditores encontrados são diferentes conforme o sexo em idosos. Concluiu-se que há relações entre capacidades físicas e o desempenho cognitivo em idosos, sendo esta última variável influenciada pelo grau de escolaridade apresentada pelo indivíduo. Ainda, cita-se a importância de adotar dinâmicas intervencionistas eficazes e mais adaptadas conforme o sexo, a fim de proporcionar uma melhora cognitiva na população idosa